Accurate diagnosis of various forms of renal osteopathy in chronic kidney disease - mineral and bone disorder


Authors: K. Žamboch 1;  J. Zahálková 2;  Z. Kosatíková 1;  P. Skýpalová 3;  J. Škarda 3;  J. Zadražil 1
Authors‘ workplace: III. interní klinika-NRE, FN a LF UP v Olomouci 1;  Nemocnice Šternberk, hemodialyzační oddělení, Středomoravská nemocniční, člen společnosti Agel, Šternberk 2;  Ústav Patologie, FN a LF UP v Olomouci 3
Published in: Čes. Revmatol., 20, 2012, No. 1, p. 20-28.
Category: Original Papers

Overview

Background:
Targeted and safe treatment of chronic kidney disease – mineral and bone disorder (CKD-MBD) can be determined on the basis of comprehensive histomorphometry of particular forms of bone disease with the presence of ordinary components. In patients with high cardiovascular risk both extreme forms of renal osteopathy (RO) can be expected in a relatively high percentage according to the rate of bone turnover with a fundamentally different therapy for each form. 

Objective:
The aim of this open, prospective pilot study is a comprehensive histomorphometry of renal osteopathy in chronic dialysis patients, assessment of the relationship between selected serum markers of bone resorption and formation and histomorphometric parameters of RO, and introduction of this method into routine practice in the high-risk group of patients with chronic renal insufficiency. 

Patients:
12 chronic dialysis patients (N-12, 8 women and 4 men, average age 74 years, average duration of dialysis treatment 38 months) with high cardiovascular calcification index (CCI). 

Methods:
Samples of bone tissue were obtained by trepanobiopsy and histomorphometrically evaluated using static and dynamic parameters of renal osteopathy. Static parameters include the determination of the volume and thickness of trabecular and spongiosa bone. Dynamic parameters were determined by identifying the tetracycline lines. Biochemical characteristics of the cohort included examination of serum markers related to bone formation and resorption. Other cohort characteristics comprised parathyroid gland volume, Z-score by DEXA examination, diagnosis of diabetes mellitus and duration of dialysis treatment. 

Results:
Statistically significant positive correlations (p<0.01) were demonstrated between the volume of bone trabeculae and type I procollagen and calcitonin, between the osteoid thickness and type I procollagen and the trabecular bone volume and serum osteocalcin. Furthermore, a statistically significant association was found between the Crosslaps, type I collagen C-telopeptides and Z-score using DEXA examination. An association between the tetracycline lines, bone volume and trabecular thickness was found, as well as between osteoid volume and the volume of bone trabeculae with the duration of dialysis treatment. Moreover, a relationship was demonstrated between the PT volume and type I procollagen. 

Conclusion:
Changes in calcium and phosphorus metabolism belong to the clinically and pathogenetically significant complications of chronic renal insufficiency. In complex cases and in patients at risk a bone biopsy with histomorphometrical examination for a comprehensive assessment of bone changes in CKD-MBD (K/ DOQi, ERA-EDTA recommendations) remain the gold standard.

Klíčová slova:
minerálová a kostní nemoc při chronickém onemocnění ledvin, histomorfometrie kostní tkáně, chronická renální insuficience 


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Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
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